This invention provides a subscription healthcare coverage system and method.
The costs of healthcare are high and are still rising, and a substantial reason for that rise is the profound expenses of administration of healthcare provision, utilization, and payments. The present administrative systems of administrative hurdles not only drive up the cost of healthcare, but can also be prohibitively confusing to patients in need of healthcare, sometimes being so confusing that the policies discourage or prevent a patient's access to healthcare.
There is therefore a need for a subscription healthcare coverage system and method that provides direct, secure communications with covered individuals and simplified administration based on flat rates, as well as automatic, fast decision-making based upon secure, quickly accessible data captured and stored in the system. The prior art does not presently provide for such a solution.
For example, U.S. Pat. No. 7,590,550 was issued to assignee American Well Inc. on Sep. 15, 2009, covering “Connecting Consumers with Service Providers.” The concept, invented by Roy Schoenberg, provides for a system wherein a request is first received from a consumer of services to consult with a service provider. The service provider has a service provider profile that satisfies at least some attributes in a set of attributes that define a suitable service provider. An available service provider satisfying at least some of those attributes of the confirmed set of attributes is identified, and then a communication is established between the consumer of services and the identified service provider, via a communication channel provided in the system. A general schematic of the system provides for appropriate connections between the set of clients and appropriate tracking, access, and scheduling server.
U.S. Publication No. 2014/0019160, published by inventors Francisco Loya, III, et al. on Jan. 16, 2014, discloses “Verifying Charge Codes.” Per the disclosure of the Loya publication, systems, methods, and computer program products involve receiving, electronically, medical information about a patient of a medical provider from an electronic medical record. A charge code associated with a medical condition of the patient can be automatically identified from a specified set of a plurality of charge codes upon which a third party will base payment to the medical provider, using the received medical information. The charge code can be outputted. In the system, after charge does are verified, they can be stored in a repository for other analyses. For example, utilization models can be generated based on charge codes identified. An example utilization model may include identifying Diagnostic Related Groups (“DRG”) that are paid for under a flat fee model. The actual costs associated with the DRG can be determined based on certain metrics that can be accumulated and analyzed. The actual costs can be compared against the flat fees collected to determine net gains and losses, efficiency of certain treatments, and so forth. The metrics and the DRGs can additionally be tracked using charge codes identified from physician reports and from other medical information for each patient. The Loya system is owned by assignee CMO RX Inc.
U.S. Publication No. 2003/0154104 was published by Alvin Koningsberg on Aug. 14, 2003, disclosing a “Method of Operating a Savings Plan for Health Care Services.” In the Koningsberg platform, a health care services savings plan highlights a savings. Data is entered, published, and updated on the plan owner's advertised web site, identifying provider entities per specialty, their regular and discounted price for each treatment type, and the service fee percentage charged by the plan. Users access the data, select the health care provider, present plan cards to the selected entities, and receive health care. The plan bills the user the regular price, issues a credit for the savings difference, with the bills separate for administration, and charges debit calculated by applying a published service fee percentage of between twenty-five and thirty-three percent to the savings difference. Electronic billing triggered is when the health care provider bills the plan by computer, and the plan electronically bills the consumer's credit card. Lastly, a prescription patient profile database is maintained and updated by a data source, with the data source including information about all prescription medication of the health care consumer.
U.S. Pat. No. 8,787,555, issued on Jul. 22, 2014 to assignee Telethrive, Inc., covers a “Process for Obtaining Expert Advice On-Demand.” The process of obtaining expert device on-demand, conceived by inventors Shlomo Gonen, Jonathan A. Conen, David Gonen, Darren Berkovitz, Stacy Stubblefield, Micah Grossman, and Jordan Michaels, includes maintaining a substantially real-time list of available experts in selected fields in an electronic database. The system receives a request from a customer for expert advice in one or more of the selected fields maintained in this database. The system then electronically identifies one or more available experts to the consumer in response to the request received, and routes the request for expert advice to at least one of the available experts. The system also provides the capability for the provider to create a profile, which in turn allows requestors to view personal information regarding the provider. Requestors may therefore make better informed decisions when selecting a provider from whom to obtain expert advice on-demand. Preferably, the profile would include 1851 information like age, gender, birthday, interests, personality traits, professional accolades, and the like. The provider contact information and corresponding profile would be submitted for administrator approval before being posted publicly Like providers, requestors may also register with the system via the same or similar process, and would include, for example, inputting contact information such as name, address, telephone number, and geographic location.
U.S. Publication No. 2011/0251851 was published by Carl Van Lierde et al. on Oct. 13, 2011, and discloses a “System and Method for Multi-Person and Multi-Site, Interactive Treatment Simulation.” The system and method allow for interactive simulation of a dental treatment. Over a communications network, the system allows a group of dental specialists to provide advice on dental treatment to be administered on a patient by a dentist. Treatment can be simulated by treatment simulation software. An advantage of the system is that any number of specialists can be brought in to instruct the dentist via treatment simulations while the dentist can focus on administering the treatment. In the system, general practitioners (“GPs”) can choose to work without or with one or more service providers for each step, and those service providers may be identical for more than one step. To indicate the desired services and to identify preferential experts, the GP would provide input to the system, which can be done by, for example, filling out an online form. Preferences per GP can additionally be stored in the system. Via a webpage, the GP can indirectly access the system's database of service providers to make a choice. The system provides functionality, such as queries, to limit the subset of service providers per step, based on one or more criteria. The system may further assist the GP by proposing a team of experts to conduct the entire set of tasks based on certain criteria, such as shortest overall lead time, smallest number of experts involved, least expensive solution, best qualifications, and so forth. The Lierde et al. publication is owned by DENTSPLY International Inc., as the assignee of record of the application.
U.S. Pat. No. 7,346,522 was issued on Mar. 18, 2008 to assignee First Access, Inc., covering a “Medical Payment System”. The payment system, invented by Dorothy M. Baylor and Kimberly A. Darling, allows for a provider of medical goods and/or services to submit, via telephone or other communications medium, a request for a payment amount determination for a patient encounter. A price determination system determines which of a plurality of fee schedules negotiated by the provider applies to the patient encounter and calculates, based at least in part on information entered by the provider, a payment amount for the encounter, which is then communicated to the provider. In one embodiment, the provider receives the payment amount information while the patient is at the point of service. In another embodiment, the provider may use the system to submit a claim for payment by at least one responsible party.
U.S. Pat. No. 8,560,338, issued on Oct. 15, 2013 to assignee TAG, LLC, covers a “Method for Competitive Prescription Drug and/or Bidding Service Provider Selection.” In '338 patent, invented by Ralph F. Kalies, Jr., unfilled prescriptions are submitted to a registry comprised of pre-qualified pharmacies for a “reverse auction,” in which the pharmacies bid for the opportunity to fill the prescription. The pharmacies are allowed to bid based on price and/or offering ancillary services. The auction may also be used to bid on supplying specified cognitive services. The method may also include obtaining cost comparisons with generic substitutes or similar alternative pharmaceutical products, and the system may further comprise automatically requesting a review by the prescriber for a list of similar substitutes or prior-authorization for third party payers. The winner of the reverse auction is ultimately selected by the customer.
U.S. Publication No. 2014/039911 was published on Feb. 6, 2014 by Sriram Iyer and discloses a “System and Method of Comparing Healthcare Costs, Finding Providers, and Managing Prescribed Treatments.” The publication discusses the use of a medical savings management system, device, and method that features a computing device configured to manage medical savings, including drug therapies, to reduce healthcare costs. Users identify medications and other treatments, determine acceptable alternatives, and identify local health care providers. Users can additionally compare costs of the identified treatments from particular local providers based upon contracted discounts, manufacturer rebates, and the availability of lower cost clinical alternatives. Based on the identified treatments, health care providers, and costs, users select a preferred treatment and provider and reduce the cost of a treatment. Additional savings may be realized by searching a larger radius for lower cost providers, and by sharing discount cards via e-mail, text messaging, and social media outlets. Users benefit from the savings and generate revenue for sponsors of the discount programs, and the system is integrated with credit, debit, and Health Flex cards to facilitate payment and reimbursement for eligible health expenses.
There is therefore a need for a subscription healthcare coverage system that provides direct, secure communications with covered individuals, and further provides for simplified administration via flat rate fees, as well as automatic, fast decision-making based on secure, quickly accessible data captured and stored on the system.